5 Tips to Ensure Your Medicare Enrollment Applications are Timely-Processed

The Medicare enrollment process serves as the gateway for physicians and other health care providers into the program. Prior to billing Medicare, the physicians must submit appropriate enrollment applications to their Medicare contractor and have them successfully processed. Unfortunately, over the last few years there have been constant problems with the Medicare enrollment process. CMS has recently stressed on addressing many of the systemic problems with this process.

Physician practices and hospitals must enroll or maintain their Medicare enrolment status, or else they will face delays in claims payment, cancellation of billing privileges and false claims liability. With frequent changes on Medicare provider enrollment requirements, it’s difficult to know exactly what to do next. The whole process has lots of reporting requirements for issues that might otherwise seem insignificant.

Here are some handy-tips to make sure that your Medicare enrollment applications are processed timely:

1.     Provider Enrollment, Chain and Ownership System (PECOS)

Use PECOS to enroll and make a change in your Medicare enrollment if it is available for your provider or supplier type. PECOS is internet-based and allows physicians and non physician practitioners to enroll and make a change in their Medicare enrollment.

2.     CMS-855

Submit the current version of the Medicare enrollment application. The revised Medicare application (CMS-855A, CMS-855I, CMS-855B, CMS-855-O, and CMS-855 R), along with the current DMEPOS supplier enrollment application.

3.     The Medicare fee-for-service contractor that serves your state or location is responsible for processing your enrollment application. Submit your application for the provider or supplier to the appropriate Medicare contractor.


4.     Submitting a complete application is imperative if you are enrolled in Medicare, and are submitting the form for the first time for any reason. Complete each section listed in Section 1B of the CMS-855.


5.     The Centers for Medicare and Medicaid Services (CMS) requires provider and supplier to get National Provider Identifier (NPI) number before enrolling or making a change in your Medicare enrollment information.


Were these tips helpful? Do you want to learn more about CMS-855 forms? Nationally renowned speaker Dr .Duane Abbey is taking an audio session on CMS-855 forms.

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